Chapter 4: Electric-field controlled correlations and emergent ferromagnetism in
3.2 Hall measurements
Indirect euthanasia, which is even more known as the “double effect,”98 takes place when a patient is given certain drugs to control/detach his pain, but it is admitted, that these drugs may hasten patient's death, especially with the increase of their dosage, which can be needed as body adapts to the medicaments, and thus will require higher quantities of it to bring the intended soothing effect. Causing death is not an intention in this case however, instead, here it is an awareness that the death may happen because of the medication, but it is justified, that by administering the drugs, only bringing of the good effect of alleviating pain is meant, which outweighs even the prospect of non-reversible side effect of death. In summary, four points must be met, for the double effect to be justified:
− the intended final aim must be positive;
95 Barnett, D. “Haleigh Poutre.” Weekly Standard. Updated - 27 Jan. 2006. Retrieved - 19 Apr. 2006 <http://www.weeklystandard.com/Content/Public/Articles/000/000/006/635seuoj.asp?pg=1>. 96 “Poutre panel recommends reforms in child welfare system.” The Commonwealth of
Massachusetts: Executive Department. Updated - 21 Mar. 2006. Retrieved - 19 Apr. 2006
<http://www.mass.gov/?pageID=pressreleases&agId=Agov2&prModName=gov2pressrelease&prF ile=gov_pr_060321_halieh_poutre.xml>.
97 Ibid.
98 “Report - Inquiry into Euthanasia Laws Bill 1996.” The Parliament of the Commonwealth of Australia: Senate Legal and Constitutional Legislation Committee. Updated - 19 Nov. 2003. Retrieved - 06 Apr. 2006
<http://www.aph.gov.au/senate/committee/legcon_ctte/completed_inquiries/1996- 99/euthanasia/report/report.pdf>. p. xii.
− the intended method to reach the aim must be morally acceptable;
− the foreseen negative consequences must not be intentional;
− the positive aim must be substantial enough, for negative effects to be justified.99
While the doctrine of double effect is believed to be established by the Roman Catholic theologians in the Middle Ages, who oppose both euthanasia and PAS,100 and is specifically attributed to Thomas Aquinas,101 studies conducted before the recent modern developments at the end of 1990s took place, have shown that the vast majority of physicians were reluctant to administer high or even sufficient doses of medicaments to their patients, because of legal and ethical concerns, and it would be probably safe to say, that many doctors are still hesitant of this practice, as arguably, it is a thin line between intending death of a patient and foreseeing it.102,103
The legality of the doctrine has been affirmed by the US Supreme Court in the case of Vacco v. Quill in 1997, where the court has stated, that “[j]ust as a State may prohibit assisting suicide while permitting patients to refuse unwanted lifesaving treatment, it may permit palliative care related to that refusal, which may have the foreseen but unintended "double effect" of hastening the patient's death,”104 making reference to the New York State Task Force on Life and the Law, recognizing that the practice is broadly acknowledged and “is ethically and professionally acceptable.”105 The practice is also affirmed by the American
99 “COBRA Issue Guide: The Doctrine of Double Effect.” National University of Ireland (Department of Philosophy). Updated - not known. Retrieved - 19 Apr. 2006
<http://www.nuigalway.ie/philosophy/cobra/double-effect.html>.
100 “Declaration on Euthanasia.” Official site of Vatican: Sacred Congregation for the Doctrine of the Faith. Updated - 5 May 1980. Retrieved - 8 May 2006
<http://www.vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_1980050 5_euthanasia_en.html>.
101 “Doctrine of Double Effect.” Stanford Encyclopedia of Philosophy. Updated - 28 Jul. 2004. Retrieved - 15 May 2006 <http://plato.stanford.edu/entries/double-effect/>.
102 Quill, T. E., Dresser, R., Brock, D. W. “The Rule of Double Effect - A Critique of Its Role in End-of-Life Decision Making.” The New England Journal of Medicine (vol.337, no.24). Updated - 11 Dec. 1997. Retrieved - 25 Apr. 2006 <http://content.nejm.org/cgi/content/full/337/24/1768>. 103 Fohr, A. S. “The Double Effect of Pain Medication: Separating Myth from Reality.”
International Association for Hospice and Palliative Care. Updated - 1998. Retrieved - 25 Apr. 2006 <http://www.hospicecare.com/Ethics/fohrdoc.htm>.
104 “Vacco v. Quill, 117 S. Ct. 2293 (U.S. 1997).” Medical and Public Health Law Site. Updated - 16 Oct. 2004. Retrieved - 24 Apr. 2006
<http://biotech.law.lsu.edu/cases/pro_lic/Vacco_v_Quill.htm>.
105 “When Death is Sought: Assisted Suicide and Euthanasia in the Medical Context.” The New York State Task Force on Life and the Law. Updated - May 1994. Retrieved - 8 May 2006 <http://www.health.state.ny.us/nysdoh/consumer/patient/chap8.htm>.
Medical Association, which distinguishes between the euthanasia and “administering a medically sound pain relief treatment which will likely shorten the patient's life,”106 difference, although being subtle, is significant nevertheless.
United Kingdom
In the UK, it is possible to trace the double effect principle being affirmed by the court as early as 1957, when Dr. John Bodkin Adams has been acquitted of administering pain- relieving medicine that caused death of an elderly patient on principle, that “a doctor is
entitled to do all that is proper and necessary to relieve pain even if the measure he took might incidentally shorten life.”107 Another case involved Dr. Nigel Leigh Cox, who in 1991 was charged with an attempted murder of his patient, as it has been perceived that the quantity of the drug he administered to Mrs. Boyes, who evidently was at best hours away from her death, has been too high to be of a therapeutic intention. Court held, that even though a physician can legally administer potentially life shortening medication, “no doctor can
lawfully take any steps deliberately to hasten that death by however short a period of time,”108 but as the evidence presented, was not clear if Mrs. Boyes died either of natural causes, as she has been literally within minutes to her death, or because of the deadly injection, Dr. Cox's sentence was suspended.
Even though the rule of double effect is widely recognized as a valid and important one, it certainly is not without its own criticism, and as it has been hinted earlier, it stems from the fact, that there is a very thin line here, between deliberating death and envisaging it. Though it is ruled out from the doctrine, that one can bring about harm, being death, as an end, some actually may and do, according to the British practitioner Dr. Michael Irwin, give life- shortening medicaments with an intention to bring about death, but “will never admit that they have given it to honor a patient's request to die.”109 This statement is seen to be affirmed
106 “Decisions Near the End of Life.” American Medical Association. Updated - 15 Jan. 2004. Retrieved - 8 May 2006 <http://www.ama-
assn.org/ama1/pub/upload/mm/369/ceja_rep_33_0104.pdf>. p. 6
107 Howard, P., Bogle, J. “Lecture Notes: Medical Law and Ethics.” Blackwell Publishing. Updated - 2004. Retrieved - 8 May 2006
<http://www.blackwellpublishing.com/content/BPL_Images/Content_store/Sample_chapter/14051 18687/howardchap11.pdf>. p. 123
108 Tur, R. H. S. “The Doctor’s Defense.” The Mount Sinai Journal of Medicine. Updated - 1 Nov. 2002. Retrieved - 8 May 2006
<http://www.mssm.edu/msjournal/69/v69_5_page317_328.pdf>. p. 322-324
in the case of Dr. David Moor, who has expressed his support of Dr. Irwin's views in media, admitting that he too has helped patients to die, but when prosecution, on the basis of that admission tried to convict him, Dr. Moor stated in the court, that he has been faithful to the double effect doctrine in his actions and operated within the law, therefore due to the lack of evidence, confirming that he had acted illegally, he was not sentenced.110 Thus it is clear, that when it comes to a real-life situations, the practice of the doctrine presents itself to be quite ambiguous, and that the intentions of physicians are not painted in black or white colors, but are multi-layered, and it well may be, that doctor wants to treat his patient's pain as much as he wishes to help that person to pass away peacefully.111